Department of Health and Human Services (DHHS) …

1 TEXAS MEDICAID BULLETIN NO. 202 INSIDEAll Providers 1 NPI Overview 1 NPI Attestation Overview 2 Atypical Provider Identifiers 3 Completing the Online Attestation Process 4 Important Medicare Crossover Information 8 Crosswalk Solution Developed for Claims Processing 9 Implementation Timelines 10 NPI Information and Help 10 New Claim Forms 11 Correspondence Changes 14 TDHconnect 15 EDI Companion Guide 15 Third Party Biller Enrollment 15 Forms 16 Revised CMS-1500 16 Revised CMS-1450 (UB-04) 17 Revised ADA Dental Claim Form 18 Long Term Care Providers See reverse sideThis is a combined, special bulletin for all Medicaid, Children with Special Health Care Needs (CSHCN)

2 , Family Planning, and Long Term Care providers. (Long Term Care providers will find information applicable to them on the reverse side of this bulletin.) This bulletin is intended to notify providers of program changes related to the National Provider Identifier (NPI) implementation occurring May of 2007 NPI OverviewThe National Provider Identifier (NPI) final rule, Federal Register 45, Code of Federal Regulations (CFR) Part 162, was published on January 23, 2004, by the Department of Health and Human Services (DHHS) as part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The rule established the NPI as the standard unique identifier for Health care providers and requires covered Health care providers, clearinghouses, and Health plans to use this identifier in HIPAA-covered transactions by May 23, 2007.

3 The Texas Medicaid, Family Planning, and CSHCN Services Programs meet the definition of Health plan and, therefore, must accommodate the NPI requirements for HIPAA-covered transactions received on and after May 23, 2007. To ensure providers continue to receive accurate and timely payment while transitioning to the NPI, HHSC and TMHP have developed a phased approach for NPI implementation. In order to meet the May 23, 2007, implementation date, providers will be allowed to submit and receive NPI and related information on most electronic transactions and paper forms. However, providers will be required to continue to submit Texas Provider Identifiers (TPIs) until July 31, crosswalk solution (see page 9) has been developed that allows providers to submit their assigned NPI while TMHP processes the transactions using the provider s TPI.

4 The crosswalk of the NPI back to TPI is crucial for accurate payment of Services . It is your responsibility to inform TMHP of your assigned NPI. Refer to page 4 for information regarding how to report your NPI to TMHP. The intent of this special bulletin is to summarize the first phase, or interim process, and detail what actions providers must take to ensure a smooth transition to the NPI. Copyright AcknowledgmentsUse of the American Medical Association s (AMA) copyrighted Current Procedural Terminology (CPT) is allowed in this publication with the following disclosure: Current Procedural Terminology (CPT) is copyright 2007 American Medical Association.

5 All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regulation System/ Department of Defense Regulation System (FARS/DFARS) restrictions apply to government use. The American Dental Association requires the following copyright notice in all publications containing Current Dental Terminology (CDT) codes: CDT4/2007 [including procedure codes, definitions (descriptions), and other data] is copyrighted by the American Dental Association. (c) 2006 American Dental Association. All Rights Reserved. Applicable Federal Acquisition Regulation System/ Department of Defense Acquisition Regulation System (FARS/DFARS) restrictions apply.

6 SPECIAL BULLETINNATIONAL PROVIDER IDENTIFIER (NPI)for Medicaid and CSHCN Services Program providersCPT only copyright 2005 American Medical Association. All rights Attestation Overviewtype and specialty. Providers may have more than one taxonomy code. (Taxonomy codes can be obtained from the Washington Publishing Company [WPC] website at )During the online attestation process, providers must select a primary and, if applicable, secondary taxonomy code associated with their provider type. Providers will be supplied a list of taxonomy codes to choose from that correspond to their specific TPI. Only the code will be displayed. Due to copyright laws, TMHP is unable to publish the taxonomy description.

7 Therefore, providers must verify the taxonomy code associated with their provider type and specialty before beginning the online attestation who submit claims to Medicare should identify to TMHP all taxonomy codes that they will submit to Medicare for each of their TPIs. The provider may identify a primary taxonomy code, but TMHP strongly recommends that providers identify all codes to ensure timely processing of claims. Provider AddressesDuring the attestation process, all providers must verify the physical address for each TPI. Providers will have the ability to update these addresses online if they are incorrect. During this process, TMHP does not require providers to submit the Provider Information Change Form and strongly encourages providers to take this opportunity to correct their contact data:Physical Address If the physical address is incorrect, the provider may update it online.

8 When updating the physical address, enter the current physical address. If needed, the provider can update this address through the attestation process again at a later date. The physical address cannot be a PO : If you are a Medicare provider, the physical address should match the primary physical address that is attached to your Medicare number. ZIP + 4 Code Providers must include the correct ZIP+4 code. This code is used during the crosswalk process (see page 9) by TMHP to identify the provider s specific account. Information about ZIP+4 codes can be found on the Postal Service website at Before submitting claims, it is the provider s responsibility to report their NPI to TMHP.

9 If an NPI is not reported, claims will deny or reject. Providers must attest to NPI data for each of their current Texas Provider Identifiers (TPI). TMHP strongly suggests that providers attest at their earliest has created a webpage on the TMHP website ( ) to enable providers to report their NPI. This page will be available on January 22, 2007. Providers will be guided through the process and must supply and attest to the accuracy of their NPI and related data (see Completing the Online Attestation Process, on page 4). Access to the attestation pages is granted through current administrative permissions; only account administrators will be able to attest online.

10 The following items are required to complete the online attestation process:The NPI assigned by the National Plan and Provider Enumeration System (NPPES)The provider s identifying taxonomy code(s) (see below)The tax identification (ID) or Social Security number (SSN) associated with the NPIThe physical address, including ZIP+4 Additionally, the following items are optional:The individual provider or group name associated with the NPIThe doing business as (dba) as provided to NPPESM ailing/Billing address, including ZIP+4 Hint: Reference the confirmation page you received from NPPES while completing the online attestation process. Taxonomy CodesThe Health Care Provider Taxonomy Code Set is an external, nonmedical collection of alphanumeric codes designed to classify Health care providers by provider Texas Medicaid Bulletin, No.